This course proposes an overview of current global health challenges drawing on the insights of several academic disciplines including medicine, public health, law, economics, social sciences and humanities. This interdisciplinary approach will guide the student into seven critical topics in global health.

从本节课中

Research, Development, Innovation and Technology for Global Health

This module addresses the lack of attention to research and development for medicines and technologies for diseases that disproportionately affect developing countries and all the issues related to drug development and intellectual property rights.

与讲师见面

Rafael Ruiz De Castañeda

Institute of Global Health - Faculty of MedicineUniversity of Geneva

Antoine Flahault

Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)University of Geneva and Université Paris Descartes – Sorbonne Paris Cité

[MUSIC]

Good morning or good afternoon everybody, my name is Peter Beyer.

I will present today on public health related aspects

of intellectual property rights.

And before I really start my presentation,

I would like to highlight a couple of facts with regard to access to medicines

and because it is important to know that between 20 and

60% of the health budget in low income countries goes to medicines expenditures.

So medicines expenditures are, in fact,

a big percentage of the overall health budget.

And this percentage of the overall health budget is paid to a large extent, in fact,

by patients.

Because in some countries up to 80 to 90% of medicines are, in fact,

purchased out of pocket as opposed to being paid for

by health insurance schemes, which you may know from many developed countries.

And today, we still have huge challenge with regard to access to essential

medicines In may developing countries.

Our surveys have shown that the public sector availability of essential medicines

is only about 46% in the public sector, and in the private sector is about 70%.

And in practice this means that if you go to your local hospital

in a given developing country, there's only one chance out of two

that you will really get the medication you need.

So there's only one chance out of two that you're going to get

the insulin you may need if you have diabetes or

the antibiotics you need to treat an infection.

In the World Health Organization,

we have developed what we call a framework for access to medicines.

And this framework consists of what we call four pieces of a puzzle and

all these pieces must get together in order to ensure,

in fact, access to essential medicines.

And one important piece is a rational selection and use of medicines.

Another is affordable prices, sustainable financing and reliable supply systems.

Today I will not be able to speak about all four of these elements because

in 50 minutes this is not feasible.

But I would like to highlight, make a couple of remarks with regard to

rational selection and use and then speak with regard

to affordable prices in relation to intellectual property.

The World Health Organization has developed since

1977, a WHO Essential Medicines List.

And in 1977 we published the first edition and have reviewed it every two years.

So we have now in 2013, the 18th Essential Medicines List.

And these lists now contain around 400 medicines

and we define essential medicines as medicines that

should be available at all times in adequate amounts

in the appropriate dosage forms and with assured quality and adequate information.

And they should be available at a price so that the community can also afford them.

And when we are selecting or when the expert committee is selecting these

essential medicines, they do not consider the patent status.

And most of the medicines on this list are, in fact, not under patent and

are available as cheap, generic versions.

But you will find a number of medicines on the list that are patented and

most of them are treatments against HIV/AIDS.

And the question around affordable prices and intellectual property

protection has been discussed mainly with regard to the case of HIV/AIDS.

And the reason for that is that HIV is a relatively recent disease,

it's only about 30 years old.

And that is why the medication we have today, many of those

products are still under patent, because the patent term is running for 20 years.

So in 2003 we had around 400,000 patients under treatment in developing countries.

And now in 2012 we have more than 9.7 million

people living with HIV who are, in fact, getting access to the treatment.

So this is a huge success for the health community and

it was possible, because the prices for the treatment went down dramatically.

In 2000 the first line antiretroviral treatment regime

still was costing around $10,000 US per person per year.

And in 2010 the most widely used first line

regimen was costing only around $120 US.

So this price decrease made it possible, in fact, to reach many more patients.

And the main reason for this decrease in price is the availability of cheap,

generic versions of these products.

It was, in fact, possible to buy most of these generic versions from

generic manufacturers, most of them in India.

And Indian manufacturers were, it was legally possible

to produce these products in India because India did not

grant product patents on pharmaceuticals before 2005.

And another reason for the decrease in prices are, of course,

the economies of scale.

The market dramatically increased from 400,000 patients to now 9.7 million,

which of course, allows for economies of scale in the production of medication.

We still have a number of challenges, second and third line treatments.

There are still a number of more recent second and third line treatment that

are expensive and where not necessarily generic sources are available.

And this is still putting a high burden on

health budgets in many developing countries.

There has been a certain trend in the management of intellectual

property with regard to HIV/AIDS medication in the past 13 years.

And if we go back to 2001, there were a number of researching pharmaceutical

companies in fact sued the South African government over parallel imports.